ap20_convert

ADPUSH - Version 1.0 --> Version 2.0 Conversion

The following form will allow you to convert your ADPUSH 1.0 account to our new Version 2.0 system.

More Information on Version 2.0 - What Does It Cost ?

ADPUSH - Cost

The Cost for the first ADPUSH 2.0 account is $19.95 per month. Each additional account is $8.50. Charges will appear on your statement on or around the 20^th of each month from Global Information Concepts. By joining ADPUSH you agree to the terms and services of operation.

Company / Personal Information

First Name:

Last Name:

Company Name:

Address 1:

Address 2:

City:

State/Province:

Zip Code: Country:

Email (Required):

Conversion Summary

YES! - Please convert my ADPUSH 1.0 Accounts!

Billing Information

This form is on our SECURE SERVER. Use it with confidence.

Payment Type: Visa Master Card

Account Number:

Expiration Date:

Name on Card:

ADPUSH 1.0 Account Information

My primary ADPUSH 1.0 Account is :

My secondary ADPUSH 1.0 Accounts are:

Account 2: Account 3: Account 4:

Account 5: Account 6: Account 7:

If you have more than 7 ADPUSH accounts please send an email to gic@qni.com

I have read, and agree to the terms and services of operation:

This form is on our SECURE SERVER. Use it with confidence.